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how to study for usmle step 3
Your USMLE Step 3 Study Plan
How to plan for Step 3 exam prep:
1. Realize that USMLE Step 3 is not like the others.
Step 3 is different from the other components of the USMLE in many ways. As a result, preparing for it requires a tailored approach that may not be the same as what you utilized for Step 1 or Step 2 CK.
First of all, the exam is divided into two separate days that can be, but do not have to be, contiguous. The first day consists of your standard multiple choice questions in a timed setting, while the second day is similar but with the addition of clinical cases. The cases cover a variety of clinical scenarios from emergency, to acute care, to chronic care, and you’ll need to familiarize yourself with triage as well as treatment. Overall, Step 3 heavily emphasizes triage and the delivery of care. And of course, don’t forget to study ethics and biostatistics.
2. Establish a timeline and a test date.
The first step in any study plan is to develop a timeline to establish boundaries regarding when you plan to take the exam and how much time you will have to prepare.
We must reiterate that leaving an open-ended Step 3 test date is strongly discouraged, as the associated perception that you have an unlimited amount of time to study may lead to inefficiency and procrastination.
Moreover, when you later attempt to book your test date, you may find that the dates previously available are no longer options and you have to defer your exam to later or travel to a distant testing center.
Which dates to select for the exam should be based on consideration of your schedule and when would be reasonable for you to both prepare for the test and have two days off to take it.
Specifically, you should be realistic about when you will have time to study. If you have a series of challenging rotations on which you will be putting in long hours, it’s probably not wise to schedule your exam at the end of said block. What would be preferable is to identify a period of time when you may be off or have a lighter workload, during which you may have nights and/or weekends available for studying.
Finally, one last aspect is how you want to schedule the two days relative to each other. Many people elect to take both parts back to back and finish the exam in two days, while others might prefer to have a break in between the days. The decision is personal, though I’d recommend taking a few days in between to recuperate and prepare a bit more for the clinical cases as they are lengthy, have a difficult user interface, and are something you have not yet encountered in your career.
3. Don’t neglect practice questions and practice tests.
The single most important component of any study plan is incorporating practice questions. Among qbanks, the best and go-to option is UWorld which, much like it did for Step 1 and Step 2 CK, incorporates the highest-yield concepts into questions with well-written and researched explanations. In fact, this is the best place to start your studying, and you should make it a priority to get through a first pass with reasonable efficiency to afford time to return to these questions and do as much of a second pass as possible. One great advantage to the UWorld qbank is that it accounts for, and will test you on, the higher-level ethics and biostatistics questions that you will encounter in the first test day.
If you finish UWorld once, or even twice, and have time remaining in your study period, you may be looking for more questions. AMBOSS is a newer qbank that also offers Step 3-specific questions through which you can work. The AMBOSS questions tend to be slightly more challenging, in that they require you to pick up on minute details in longer vignettes in order to arrive at the right answer.
Regarding practice tests, your choices are the same as they were for the previous board exams and specifically are the NBMEs and UWorld Self-Assessments. It is worthwhile to at least do the latter and then consider also purchasing the former as time permits. While these tests will result in a three-digit conversion of your raw score, you should note that they are not full-length and only cover concepts tested in the multiple choice components on the exam days; they do not incorporate the CCS component which you will have to practice separately as described below.
4. Buy a textbook to assist your Step 3 studying.
Regarding textbooks for Step 3, much like Step 2 CK, a single stand-alone textbook does not exist as the go-to resource in the way that First Aid is for Step 1.
To that end, there is no single option that you should feel compelled to use. One textbook that is worth looking into is First Aid for the USMLE Step 3. While it’s not realistic or practical to read this or another similar resource from cover to cover, one way that it may be incorporated is by using it as a secondary resource to take a deeper dive into certain topics you self-diagnose as areas of opportunity.
For example, if you feel like you are consistently getting questions about the indications for different classes of antiarrhythmics wrong and, despite the question explanations, still do not have a clear framework for how to think about these medications, it may be worthwhile to review this section in the textbook you choose. What is not necessary or advisable is spending excess time reviewing the entire cardiology chapter to relearn concepts with which you already felt comfortable.
5. Use computer-based case simulations.
A unique aspect of Step 3 is the Primum® Computer-based Case Simulations (CCS) component of the exam. While the multiple choice components of Step 3 may be very similar to what you had experienced on Step 1 and Step 2 CK, this part will be very different. The single most important recommendation for approaching these cases is to become familiar with the software and how you will be timed and scored.
Specifically, on the day of the exam, you will be presented with thirteen cases which start with a brief patient vignette including whether the context is an emergency department or an outpatient clinic and routine vitals signs. It is then your responsibility to perform a physical examination and begin to order diagnostic tests and begin to develop a therapeutic plan.
As you work through these cases, there are two simultaneous clocks running. One clock counts down how much real-world time you have remaining in the simulation which generally starts at ten or twenty minutes. The other clock moves forward in simulated time to correspond to the evolution of the condition of a patient.
If this seems confusing, you should rest assured that it is not intuitive for most people. However, for that reason, it is all the more important to do the practice cases within the UWorld interface to develop dexterity with placing orders in this simulated context and hone your clinical reasoning. If you finish these with time to spare, there are so-called printable cases that walk through additional examples so that you can continue to familiarize yourself with the rubrics with which you will be scored.
how to study for step 3 before residency
How To Study For Step 3 With Residency [Step-By-Step]
Plan Your Step 3 Test Date
So the first thing is understanding that Step 3 has two test days with a break in between.
Most people will have a few days to a week between the two days of their exam. This is for a mental break and to also make sure that they can study for the second part of the exam, which also includes the clinical cases that are unique to set three.
So once you understand that the two days usually will have some gap in between, you want to make sure that you’re taking the test during a lighter rotation.
I personally took it over Thanksgiving weekend. So I took it on a Saturday and took the second part of my exam on a Monday. So I had that Sunday and the rest of the Saturday evening off.
And you want to make sure that not only are you taking the test on a lighter rotation, but that you also study for the test on a lighter rotation.
One mistake I made was I went ahead and scheduled my test while I was finishing up an ICU rotation. So my ability to study effectively had gone down and up depending on how busy I was.
And so that is really going to affect how effective your studying is. You can look at a time throughout your calendar where you’re not on call, and when you can have your weekends off or you just have a good amount of days off. That will make up for the days that you are busy.
And as a bonus step, try to get Step 3 out of the way as quickly as possible. Doing clinical rotations in your intern year, whatever specialty you’re in, will help you out. But you also are likely to forget the things that are unrelated to the field that you’re going into.
So if you’re a medicine physician like me and you’re gonna figure out all of the OB-GYN knowledge that you learned during medical school, it’s probably more advantageous that you take it quickly in your intern year and do the studying while you’re on a line of rotation.
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Your Study Approach
Once you get the Step 3 schedule out of the way, next, we’re gonna talk about your study approach.
Limit Your Resources
Now, the first thing you really want to keep in mind is you want to limit the kind of resources to those that provide questions.
You don’t have time to read and watch videos as you did back in medical school. You probably didn’t have time to do it then, and you definitely don’t have time to do it now.
So just limit your resources to the questions. And I really only recommend using UWorld plus the cases that come with it. And it just helps you to simplify. This is all you really need.
There’s not much like ancillary or support resources that you have to add on to do well on Step 3.
And in terms of how long you need to study, it just depends on how quickly you can get through the questions and the cases, as well as giving a little bit of time at the very end to review and focus on your weaknesses.
And so as the making of this article UWorld currently has about 1600 practice questions for all of their multiple-choice sections. This doesn’t include all the cases that they have on top of it, as well as other resources and exams.
It’s definitely a lot, but I recommend that you try to get through as much if not all of it as possible.
A nice way to break this down, so you can have a manageable study schedule, is to find that time of the year when you’d like to take Step 3. And then account for how many days a week you would study.
So let’s say you want to take the test in March and you have a lighter rotation at the end of March, as well as February. So ideally, that gives you the opportunity to study five days a week. For a busier rotation, study maybe three or four days a week.
As soon as you can do that, then you can divide the 1600 practice questions by the number of days or weeks in between and get an idea of how many questions you’ll have to do per day.
Obviously, this number is just an average. This is the problem that I personally ran into.
You might think that you only have to do 40 questions a day, but there are going to be some days where you either don’t study because it was a longer day than you expected, or you had no motivation to do so.
But just keep in mind that if you do have days off on the weekends or a day off after your call day, you can do two blocks or more questions on those days to make sure you don’t get behind.
Don’t Cram Your Study In A Month
Avoid falling into the trap (many residents do) where you only give yourself about a month and then you study during a busy rotation.
Sometimes you’ll end up having to be in a situation where you have to do about 80 to 120 questions a day just to get through all of your practice questions.
Usually, residents tend to not finish all of the valuable practice questions that they paid for and could potentially help them do better on the exam.
To counteract that problem, make sure you plan your study prep and look at your calendar first before scheduling the exam. That way you can give yourself enough time to start doing the UWorld questions without it becoming overwhelming.
And as you’re answering the questions, I really recommend just answering the questions randomly. There’s no real benefit for answering them by part like you did for First Aid for Step 1, where you have cardiovascular on day one GI on day two, for example.
It’s probably more advantageous for you to have all of the questions of OB-GYN, urology, and pediatrics mix. So that way you can see the topics where you are strong or weak at.
And as you’re missing questions or as you’re getting questions correctly but for the wrong reasons, make sure you’re marking them. This is so that you can go back to those questions and make sure that you’ve reviewed those topics so you don’t miss them on the actual test day.
Use The Excel Method
Now, one of the things that I was personally doing to keep track of all of my missed or marked questions is what I call the Excel method.
And if you are more interested in how I use it for Step 3, you can check out our modules in the Med Elite Academy.
Basically, I was taking all the content that I was missing on UWorld and making sure that put them nicely into an Excel sheet so that I could look at it during my review week, the night before exam, as well as when going to the exam. This is to feel comfortable that I have now understood the topics I’m weak at, and that I should be good for test day.
Now, as you’re going through your studying, all I recommend doing is just answering the UWorld questions and getting through as many as possible, and making sure you’re not getting very far behind.
3-4 Weeks Before The Exam
But during the last few weeks, about three to four weeks away from your exam, I recommend starting to do the cases which will show up on the second day of your test.
Now you probably haven’t done anything like these cases before, because it’s a completely different interface.
I do recommend that during the start of your prep, or even before these last three to four weeks, to do the first four or five cases in UWorld so you can see what these cases look like. Whether you choose to do these cases towards the end of your prep or kind of intermixed is up to you.
I found it to be a little bit harder doing them intermixed because I found my focus was just alternating, but I do recommend doing the first four to five cases.
You can get an idea of what the cases are like and what type of things you have to consider. And then just keep that in the back of your mind during the last three to four weeks of doing a few cases a day.
Now, they aren’t very long cases. Honestly, you learn more by just doing the cases as quickly as possible and then reading the explanations on what type of things you should have done that you probably didn’t, and things that you did that you probably didn’t need to.
And using your study approach, whether it’s through an Excel method like what I used or something else, you can have some type of collection system. For example, you can say: I have a patient for DK on my cases, these are the things I’m going to do.
Do the cases a little bit early on to get familiar with the format and then just go through them as quickly as possible.
Anything can show up on test day. That includes pediatrics, OB-GYN, general hospital medicine, as well as general outpatient medicine. Do as many of the interactive cases where you’re actually the one who is putting in the orders, as well as the practice cases where they just walk you through the approaches.
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1-2 Weeks Before The Exam
Now, once you’re getting closer about a week or two before your exam day, I recommend doing at least one self-assessment.
Make sure that you’re doing okay on your practice questions, especially if you’re going through the practice questions on UWorld quickly. You may not get the highest percentage of correct answers and that may give you a little bit of anxiety. But I do recommend putting yourself in a test environment and doing about four question banks back to back using UWorld
Now, one thing to keep in mind is that the self-assessment is a little bit more strict and harder in terms of grading. Probably not a real thing, but that’s because the self-assessment doesn’t include any practice cases.
Just keep that in mind. Don’t pay much attention to the score, but more on your stamina and your ability to work through those problems that have the same difficulty as the actual thing.
And another thing I do recommend doing within the last two weeks of your exam is to start the biostats section of the exam prep.
Now it may seem like a lot of stuff is going on: residency, doing the cases, as well as the practice questions.
And so what you need to do as you are going into the last week of your exam is to back away from the cases. Ideally, you do a little bit more of them towards the last three to four weeks. On the last week, you can lessen the time for the cases so you can do more of the biostats questions.
There are about four to five questions per section of the exam, and maybe sometimes even two or three. So it’s not a lot of questions but they do quiz you on the ability to understand some nuances.
So a lot of things you may be asked are things like sensitivity, specificity, things that we all hate. Other things like positive, predictive value and likelihood ratios, and other things that sound pretty familiar, may be confusing and may give you a little bit of anxiety on test day.
You want to make sure you do those practice questions first on UWorld. That way, when it comes test day, you’ll probably end up getting those right.
In addition to going through your biostats questions, have some systems. So when you’re done with your UWorld questions, you can then review your weak points. One thing that I intended to do was doing all of my missed questions again, but I simply didn’t have enough time.
So I had a system where I was able to review my weak points through the Excel method.
But you can create any system you want that helps you go back to the topics that you missed. I would do that during the last week or two.
So again, through the last week or two before the exam, do one self-assessment and try to go through the biostats questions.
Ideally, you’ve done enough of the cases by now. If not, you can quickly get through them so you can back away and practice your weak points.
During the first day of your exam where there are no cases, I would probably not do any more cases. I would just focus on the practice questions and the weak points. And then maybe during the gap in between test number one and test number two is where I would do the cases.
So if you have a week in between two of the exams, that’s awesome. Just do the clinical cases. Now, if you only have a day like I did, then obviously, you’re going to have to do some cases during that last week.
But keep in mind that if you do want to have a good bit of a break in between both of them, then try to split day one and day two by a week.
But if you just want to get the test over with as I did, then you’re just going to have to fail to get enough of the cases done during your initial prep. And so during that last week, you’re not overwhelmed by doing cases and practice questions.
Summary
I know that was a lot so here’s a little bit of an overview.
Look at your calendar and find a lighter rotation for both your test day as well as the prep. One to two months is more than enough to be a very relaxing prep. A one-month prep may get a little stressful, especially the last few weeks, but it’s totally up to you.
Work backward on how many weeks or how many days in a week you want to commit to for UWorld. And that includes how many questions you plan on doing. You may miss a day but make sure that on your days off you do a little bit more to catch up.
Have some type of review system, whether it’s the Excel method or something else to keep track of the things you miss. And then during the last few weeks, whether it’s the last three to four weeks, start doing some of the practice cases and try to get through as many of them as early as possible.
So on your last week, you can just do the self-assessment, the biostat section, and then the last few cases and reminders on your weak points. That makes you ready for testing.
